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General NPI Number Information
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NPI Number | 1801281779
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Entity Type | Individual
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Provider Name | JORDAN ERNST DPM, MS
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Gender | Male
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 1600 W COLLEGE ST STE 100
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City | GRAPEVINE
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State | TX
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Zip | 76051-3575
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Country | US
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Telephone | 817-421-0505
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Fax | 817-421-6060
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Provider Business Mailing Address
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Address Line | 3155 STARS AND STRIPES WAY APT 471
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City | GRAPEVINE
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State | TX
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Zip | 76051-1520
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Country | US
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Telephone | 402-881-1522
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 3012
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO3988
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License Number State | FL
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